MEDICARE: COLLEEN AMUNDSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37PC00602300	NJ

General Provider Information

NPI Number	:	1245802792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN AMUNDSON LPC

Provider Business Mailing Address
First Line	:	PO BOX 494
Second Line	:
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-0494
Country	:	US
Telephone Number	:	201-207-1753
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 W CRESCENT AVE
Second Line	:
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-1527
Country	:	US
Telephone Number	:	201-207-1753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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